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Mental Health Intake Form

The mental health intake form is a document that captures the details of an individual's experience with their mental health. By using an online form, you can gather the necessary information in a standardized way before consulting with the patient. This mental health intake form template was created to help clinicians streamline the data collecting process and worm more efficiently.

GUNAKAN TEMPLATE

Mental Health Intake Form

GUNAKAN TEMPLATE

What is a mental health intake form?

A mental health intake form is a document used by mental health professionals to gather information about a patient's mental health history. The form includes questions about the patient's symptoms, psychiatric history, and family history of mental illness.

If the patient has the ability to make decisions for his/her life, these inquiry forms should be filled out by the patient. Otherwise, the mental health intake form should be completed by someone who has had contact with a person in crisis and can provide information about their relevant history, current symptoms, and risk factors for suicide or self-harm.

Some details you can gather with a mental health intake form

When creating the mental health intake form, it is important to ask for as much information as possible. The following are some key points to consider:

  • The individual's name and contact information
  • The date and location of the incident/emergency
  • The nature of the crisis (e.g., thoughts of suicide, self-harm, psychosis, etc.)
  • The individual's current mental state
  • Any previous mental health treatments or hospitalizations
  • The individual's family history of mental illness
  • Any recent major life changes or stressors
  • The individual's current medications and dosages
  • Any other relevant information

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